Professional Documents
Culture Documents
PERSONAL HISTORY
IOM/KSU/014/2024
1. A) Surname: PATRICK First Name: ALFRED Middle Name: DIONICE Maiden Name, if any
3. A) Present Residence (Specify City, Province or State, Country) B) Since (date) Until (anticipated date) C) Telepho
TANZANIA 15/07/1995 +255 757 4
E) Passport or Identity Card No. Date of Issue/Date of Expiry Place of Issue (in full)
19950715274310000327 MARCH 2031 TANZANIA
Male |√_| Female |__| Single |_√_| Married |__| Widow(er) |__| Divorced |__| Separa
7. Have you any depedents? Yes |_√__| No |___| If answer is "Yes" give following information:
Name Age Relationship Name Age Relationship
DOMINA K. BUKHAY 48 MOTHER
8. LANGUAGES
(List mother tongue first)
READ WRITE SPEAK
Language
Excellent Good Poor Excellent Good Poor Excellent Good
IRAQW √ √ √
SWAHILI √ √ √
ENGLISH √ √ √
9. EDUCATION: Give full details, using the following space in so far as it is appropriate of schools or other formal training or education from age 14 (e.g. high school,
technical school, apprenticeship, university or its equivalent):
12. List activities in civic, public or international affairs and name any significant publications you have written.
I. Gave HIV training to citizens within projects vicinity
II. Performed EIA for the projects
15. In the event of your being selected, how much notice would you need before appointment? IMMEDIATELY
16. Have you any objections to our making inquiries of your present employer? Yes |___| No |__√_|
17. EMPLOYMENT RECORD: Starting with your present occupation, list in reverse order each activity in which you have been engaged, accounting fully for your
time. List military service and any period of unemployment of more than six months' duration. Use a separate block for each period and additional sheet if
necessary.
18. References: List three persons not related to you who are familiar with your character and qualifications. Do not repeat names of supervisors listed under
Item 17.
Name in full (Direct Supervisors) Telephone Number and Email Business or Occupation
19. (a) Have you ever been arrested, indicted or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned or placed on
probation in connection with such a proceeding, or have you ever been arrested or required to deposit bail or collateral for the violation of any law or regulation,
civil or military (excluding traffic violations)?
NO
Answer ''Yes'' or ''No''
(b) If your answer is ''Yes'' under item 19 (a) above, attach separate sheet giving details of all arrests and fines other than minor traffic violations. Specify
charge, date, place where arrested, and disposition.
20. State any other relevant facts. Include information regarding any residence or prolonged travel abroad, give dates, areas, purpose, etc. State any significant
experience not included in Section 17 which you believe will serve in the evaluation of your record.
N/A
21. State any disabilities which might limit the performance of your work.
(Appointment is subject to compliance with medical requirements.)
NO DISABILITY
Having answered every question above, I, the undersigned, declare that the information contained in this form is, to the best of my knowledge, true, complete
and accurate, knowing that, if employed, any false declaration or concealment of material facts may result in disciplinary action including dismissal.
Applications will not, as a general rule, be valid or retained by the Organization for more than one year from date of receipt. While you may rest assured that
your candidature will be carefully examined, receipt of this form will not be acknowledged, and any further correspondence will be initiated by the
Organization.